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This journal article explores the effects of risky sex in adolescence and its consequences. It is a peer reviewed journal article, and is a credible source.

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Statistics on USA contraception use by teens and young adults. A credible, peer reviewed journal article.

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This news article by Vanity Fair contributes to the moral panic of teen sex and the associated risks. It is biased and not credible, as it is opinionated.

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NOTE: Some of the names and identifying details in this story have been changed.
THE TINDER GUY
She wanted it to be like the scene in the Lana Del Rey video for "Blue Jeans"-"hot and slow and epic." The scene where strangers meet and fall into an easy intimacy, making love in a pool-"and they look so hot and it's just, like, totally epic." A boy at her school-she didn't want to talk about him now; he'd broken her heart; but "like, whatever." She'd "deleted him" from her phone. "I was stalking him too much, seeing him doing fun things on Instagram, and it hurt."

They'd been instant-messaging on Facebook, and one night he told her he loved her. And then "I found out he was talking to, like, four other girls." And now she wanted to do something to get over it, maybe to get back at him. "I mean, I should have known. All men are basically whores." When he didn't turn out to be her "true love"-"like Bella and Edward, or Bella and Jacob, you know?"-she decided she had to "lose it to someone," so why not with someone she would never have to see again? And yet, she hoped it would somehow be like the Lana Del Rey song. "I will love you till the end of time," it goes.

The guy she was supposed to meet that day-the guy from Tinder, the dating app kids were using to hook up-"I know, like, five guys who've done it; girls use it too, but they pretend like they don't"-he was cute and had tattoos on his arms. He looked "James Franco-ish," but younger. On Tinder you could meet people in your age group. She was 16; he was 17.

Alone in her room, the night before, reading her friends' Twitter feeds and watching YouTube videos (Selena Gomez and "baby animals being cute"), she'd started feeling lonely, restless, and bored. "Sometimes I just want to talk to a guy so bad." So she downloaded the app and started swiping through the pictures of boys in her area. She "hearted" his picture, and within a few minutes he had hearted hers, and then they were instantly texting.

"Ur hot," he wrote. "U wanna meet?"

"When?"

They arranged to rendezvous at a shopping mall in Los Angeles not far from the neighborhood where they lived. "Of course it was going to be a public place. And if it turned out he was really some gross old man, I'd just run away." But there he was, standing by his car, looking almost like his picture. . . . Almost. There was something different about his face-it was "squishier. Like, he was almost fat." But now here they were, and she didn't know quite how to get out of it.

He smiled and kissed her on the cheek. He smelled of Axe Body Spray. She was sorry she'd spent so much time getting ready for this. "I even waxed," she said. He wanted her to get in his car, but she knew she shouldn't. They started walking around the mall, "talking about nothing, nothing. It was awkward, totally weird." He asked if she wanted to sit down, but there was nowhere to sit except in restaurants, so they wound up going inside a Pottery Barn and making out on a couch. Later she posted something on her Tumblr blog about the difficulty of finding love.
WHEELING IN THE BITCHES
"Gotta wheel the bitches in. Gotta wheel the bitches in," said the teenage boy on a city bus in New York. "Nowadays you can do it so easy. There are so many apps and shit that just, like, hand you the girls. They don't even know that's what they're doing, but really they're just giving teenagers ways to have sex."
SEX, LIES, AND SOCIAL MEDIA
If you're between 8 and 18, you spend more than 11 hours a day plugged into an electronic device. The average American teen now spends nearly every waking moment on a smart phone or computer or watching TV. This seismic shift in how kids spend their time is having a profound effect on the way they make friends, the way they date, and their introduction to the world of sex.

Kids have always been interested in sex, of course; but there have never been more ways for them to express that to one another, at any moment of the day, no matter where they are. They don't even have to be together, and often they are not. "You can be sitting in class getting a boner 'cause some girl is texting you that she wants to suck your dick," said a boy in L.A. "It's kind of distracting."

As quickly as new social media appears, teens seem to find ways to use it to have sex, often sex devoid of even any pretense of emotional intimacy. There's sexting, and there's Snapchat, where teenagers share pictures of their bodies or body parts; on Skype, sometimes they strip for each other or masturbate together. On Omegle, they can talk to strangers, and sometimes the talk turns sexual. A boy in L.A. told me about a boy he knew who had a PayPal account where he accepted payment for being sexual online with "random guys . . . Two hundred bucks." And then there is Tinder, where kids can meet each other on their phones. "It's like Grindr used to be for gay guys, but now kids are doing it," said a girl in L.A. "No one cares about anything but how you look."

"We don't date; we just hook up," another girl in L.A. told me. "Even people who get in a relationship, it usually starts with a hookup." Which can mean anything from making out to having sex. "When you have sex with a guy, they want it to be like a porno," said a 19-year-old girl in New York. "They want anal and oral right away. Oral is, like, the new kissing." "The cum shot in the face is a big thing," said another girl.

And then there are "texting relationships," a disembodied coupling that takes place solely on a screen. It can still become very sexual, often very quickly. "Guys you know from just, like, having one class together will be like, 'Do you like to suck dick?'" said a 17-year-old girl in New York. "And if you say no, they just move on to the next person."
THE GIRLS AT THE GROVE
"Social media is destroying our lives," said the girl at the Grove.

"So why don't you go off it?" I asked.

"Because then we would have no life," said her friend.

The girls had been celebrating a birthday at the busy L.A. mall, and now they were on their way home; they carried bags of leftovers from the Cheesecake Factory. There were four of them: Melissa, Zoe, Padma, and Greta.* They stopped to sit down and talk awhile at an outdoor table.

They were pretty girls with long straight hair-two blonde, two brunette, all aged 16. They wore sleeveless summer dresses and looked fresh and sweet. They went to a magnet high school in L.A.

Greta, they said, was famous-or Instafamous, having thousands of followers on Instagram. She showed me a gallery of her Instapics; some were of her dog and some were of Greta pouting and wearing "the duck face." Some of her followers, she said, were "random dudes in Italy and Arabia."

Melissa said, "I have Facebook, a YouTube account. I've used Twitter, Instagram, Snapchat, Vine . . . "

"Path, Skype," Zoe said.

"Tumblr," said Padma.

"I have a Twitter, but I don't use it except for stalking other people," said Greta.

They all laughed knowingly.

"I think everyone does it," Greta said. "Everyone looks through other people's profiles, but especially being teenage girls, we look at the profiles of the males we find attractive and we stalk the females the males find attractive."

"It's a way to get to know them without the awkward 'Oh, what do you like to do?' You already know," said Padma.

"You can know their likes and dislikes," Greta said. "'Oh, they like this band.' So you can, like, casually wear that band's T-shirt and have them, like, fall in love with you or something. Or you can be like, 'Oh, they listen to that music? Ew. Go away.'"

I asked them how they knew when a boy liked them.

"When a boy likes your [Facebook] profile pic or almost anything you post, it means that they're stalking you, too. Which means they have interest in you," said Zoe.

I asked them how they made the transition from social-media interaction to real-world interaction.

They blinked.

"You talk to them on Facebook; you do chat with them," Melissa said.

I asked if they had boyfriends.

"There's this boy Seth," said Greta, "and when he liked my profile picture, I knew it was like, 'Hey, 'sup, you cute.' Then we held hands at a party. We were cute. But the one thing I didn't like about him was he didn't follow me back on Instagram. Social media causes soooooo much anxiety."

They all agreed on that.

"The thing with social media is, if a guy doesn't respond to you or doesn't, like, stalk you back, then you're gonna feel rejected," said Melissa.

"And rejection hurts," said Padma.

"And then you're gonna go, like, look for another person to fill that void and you're gonna move on to stalking someone else," Melissa said.

"That's how men become such whores," said Greta.

"Guys actually take the Facebook-talking situation way too far," meaning sexually, said Zoe.

They were nodding their heads.

"Like, when guys start a Facebook thing, they want too much," said Padma. "They want to get some. They try with different girls to see who would give more of themselves."

"It leads to major man-whoring," Greta said.

"They're definitely more forward to us online than in person," said Zoe. "Because they're not saying it to our faces."

"This guy Seth, who is normally timid in real life," said Greta, "sends girls messages asking for nudes."

She showed me a text exchange in which Seth had asked her to "send pics"-meaning nude pics, a request Seth had punctuated with a smiley face. Greta had responded "Lololol" and "Hahahaha" and "Nope." "It wasn't THAT funny," Seth had texted back.

"He isn't my boyfriend," clarified Greta.

"My friend, she was VC-ing," or video chatting, "this guy she was kind of dating," Melissa said. "He sent so many nudes to her, but she wasn't trusting that he wouldn't show the pictures to other people. So she Skyped him and showed him nudes that way. He took a screenshot without her knowing it. He sent it to so many people and the entire baseball team. She was whispered about and called names. It's never gone away. He still has it and won't delete it."

I asked if they knew girls who posted provocative pictures of themselves. They all said yes.

"More provocative equals more likes," said Greta.

"It attracts more guys and then it makes other girls think about doing it just for the attention. They're attention whores," said Padma, frowning.

"My father thinks all my photos are provocative," Greta mused.

"I think some girls post slutty pictures of themselves to show guys the side to them that guys want to see," said Zoe. "It's annoying."

"Girls call them sluts. Boys call it hot," said Padma.

Greta shrugged. "I call it hilarious."
MIRROR, MIRROR
In the video for "We Can't Stop," Miley Cyrus writhes around on a bed, sticking her ass up in the air. She grinds her ass into the crotch of a woman twerking. She writhes around in an empty bathtub, sticking her ass in the air some more. She appears at the V.M.A.'s twerking into the crotch of Robin Thicke, causing an international sensation.

In the video for "Summer Fling," Willow Smith stares at the nipple of a teenage boy while offering him her phone number. Willow's 12. She sings about having a summer fling: "It's just a couple nights, but we do it anyway." A boy shoots water into a pool party at which Willow and her bikini-clad friends jump on a trampoline, spreading their legs.

"Of course girls want to emulate this stuff," Kim Goldman said one afternoon at her home. Goldman is the director of the Santa Clarita Valley Youth Project, a counseling service for teens that reaches around 23,000 kids in 14 schools in the district. (She's also the sister of Ron Goldman, the man slain along with Nicole Brown Simpson, the ex-wife of O. J. Simpson.) "Girls talk about feeling like they have to be like what they see on TV," she said. "They talk about body-image issues and not having any role models. They all want to be like the Kardashians. Kendall Jenner posts bikini shots when she's 16 and gets 10,000 likes, and girls see that's what you do to get attention."

Santa Clarita, an affluent community nestled in the arid Santa Susana Mountains north of L.A., has its share of troubled kids. There's been a rash of heroin-related deaths over the last year. A Facebook page entitled "Santa Clarita Sluts" was finally taken down. In January, Michael Downs, a local teen, was sentenced to 15 years in prison for sexually assaulting 15 girls (one a 12-year-old), many of whom he met on Facebook.

"We're seeing depression, anxiety, feelings of isolation," said Goldman. "I think social media is contributing to these things. We have kids who've had sex with people they meet on Chat Roulette. At one of the junior highs we work with, we found out there were a few kids engaging in an online orgy. They all signed into a video chat room." One of their parents walked in on it.

"We had girls selling oral sex for $10 and $15 in the bathroom at a school," said Goldman. "Sex is everywhere. Everything is sexualized. They're all reading Fifty Shades of Grey."
CYBER-QUEENS
On a bright, hot day in June, I met Sydney at the Popover Café on the Upper West Side. She was blonde and angelic looking, like a girl from a Beaux Arts painting of the 1890s; she was 17.

She gave me her headshot; I'm not sure why. She said she wants to be an actress.

"I was cyber-bullied when I was younger," she said over popovers, "on this [social-media site for kids]. It was this thing where you create a profile of a cartoon character, and this random stranger started talking to me and saying really creepy things. I was in sixth grade.

"I didn't know who it was at first. It turned out it was one of the girls at my school," a private girls' school in Manhattan. "She was saying, like, all this sexual stuff. I don't even know how she learned how to talk that way.

"I was 11 years old, and I didn't know how to respond. And then she and her friends took screenshots [of the conversations] and spread them around and started calling me a slut." She winced.

"I was completely traumatized. I had to switch schools. I became insanely insecure." But nothing ever happened to the girls who bullied her. "I begged my mom not to bring the school into it. I didn't want to be that girl that tattletaled."

And then a few years later, she saw her former victimizers on Facebook. "They kept stalking me and I was curious, so I friended them back." That's when she found out that these girls had become "famous."

"In New York every kid knows each other," and some kids are "famous," Sydney said. "Everyone's obsessed with the feeling they have fame. They post pictures of themselves at certain parties. They friend certain kids. There's so much social climbing."

Her bullies were now two of the most visible girls in the Manhattan high-school scene, the type of girls who "go clubbing with 21-year-olds" and get invited to "events." "One of their moms has, like, a clothing line." On her iPhone, Sydney showed me the girls' Facebook pages, where they had posted many pictures of themselves partying in nightclubs and posing, hand on hip, Paris Hilton-style, surrounded by Euro-looking men. These pictures got a lot of likes.

"They dress like sluts," Sydney said, "in bandeaus and short shorts that show your butt cheeks-excuse me, you're not at the beach." She admitted she sometimes dressed like that too. "Because if you don't, you will get shunned. Girls are just so mean.

"I don't go into the bathrooms at school," she said, "'cause they just say mean stuff to you. They look at you up and down like, 'What are you wearing?' Social media makes it so much worse. Like on Ask.fm"-a social-networking site with 65 million users, half under the age of 18, on which subscribers are invited to speak their minds about each other-"they just say mean, mean, mean, mean things.

"I love Tumblr," she said, "'cause it's just kids expressing themselves with writing and pictures; but it's also a lot about how to look and dress, and it makes a lot of girls feel bad 'cause there'll be beautiful girls with beautiful everything and everyone re-posts it, and, like, it makes you feel bad about all the things you're doing wrong.

"On Tumblr there's 'The Rich Kids of Instagram,' which is these kids trying to show off their wealth, and it's so not O.K., it's revolting, but it still makes me feel bad about myself-kind of like I'm not part of it."

She said there was a term for this, FOMO-fear of missing out.

She told me about parties where girls "literally wear nothing" and kids take Molly, MDMA. "The 'in' thing for girls to do is to really just go nuts at parties, just go insane. They feel like the more they drink and the crazier they act, the more guys will come to them." Crazy how? "Dancing around, flashing their boobs."

At these parties, she said, which take place "at people's houses or a space somebody rents out to make money," "people hook up with more than one person. It's dark and, like, 100 kids are there. It's not considered a big deal. Guys try and hook up with as many girls as possible."

"At one party?" I asked.

"Yeah," she said. "They have lists and stuff. This kid in my grade has this list of 92 girls he's hooked up with."
"BAD GIRLS"
"We know this girl Ursula that had a list of guys she had given blow jobs to, like 45 people," said Sarah. Sarah and her friends Elena, Jeff, and Abby, all teenagers from the Valley, were having dinner in L.A. one night before going to a movie.

Over burgers and fries at an outdoor café, they started talking about the "bad girls" at their high school.

"Ava's like that too," said Jeff. "She asked me out and then took my head and, like, shoved it in her bra."

"She gave Richie a hand job on the back of the bus going to band competition," said Sarah.

They talked about girls who had made sex tapes; girls who had sex with different guys at parties every weekend. "Was that the same weekend she went to the emergency room [for drugs]?" asked Abby.

"Remember when Anita got semen on Maya's jacket?" Jeff asked with a smile.

"And then Maya posted it on her [Facebook] wall," Sarah said with a laugh.

"She asked to borrow Maya's jacket and she wore the jacket, and she gave this guy a blow job at a party while she was wearing the jacket," said Jeff.

"And then she gave the jacket back to Maya without washing it, so Maya took a picture of the jacket with the stain and posted it on Anita's wall: 'You didn't wash my jacket,'" said Sarah.

They laughed.

"Which was so mean, but I love that she did that," Jeff said. "I was like, 'Oh my God. '"

They laughed again.

"There was this girl in 10th grade who was gonna be on My Super Sweet Sixteen, " said Jeff. "I don't think it ever aired. That same girl, she was in a porn video going around school. People were in math class watching the video."
SELFIES
"I first started seeing people doing selfies in sixth grade," said Emily, a senior at a private school in L.A. "Back then everybody was on MySpace. In sixth grade everybody started getting phones and they started posting pictures of themselves, and it was weird, 'cause, like, a lot of the pictures were supposed to look sexy and they had the duck face and we were all, like, 11."

"Guys do selfies, too," said Alexandra, a girl at a public high school in L.A. "They post pictures of themselves smoking weed and drinking codeine cup"-a narcotic mixture of Jolly Ranchers, cough syrup, and 7-UP-"like, 'Look how boss I am, look how gangster.' They think that makes them hot. If a guy posts a picture in his boxer shorts, people say that's funny, but if a girl does it, they say she's a slut. It's a double standard, but girls still do it 'cause it gets them more likes on Facebook."

"My little cousin, she's 13, and she posts such inappropriate pictures on Instagram, and boys post sexual comments, and she's like, 'Thank you,'" said Marley, a New York public-school girl. "It's child pornography, and everyone's looking at it on their iPhones in the cafeteria."
SEXY BABIES
Jill Bauer and Ronna Gradus are the co-directors of Sexy Baby (2012), a documentary about girls and women in the age of porn. It follows three subjects: Nichole, 32, a porn star who bemoans the mainstreaming of porn in the digital age (she thinks it's unhealthy); Laura, 22, who has plastic surgery on her labia (her ex-boyfriend deemed them unattractive) so that she can "look like a porn star"; and Winnifred, 12, a middle-school student in New York who does sexy photo shoots with her friends and posts them on Facebook. Winnifred also posts a video of her little sister dancing around provocatively to a pop song.

Gradus, a photographer for *The Miami Herald,*was on assignment shooting strip clubs in Miami in 2009 when she first encountered young women who were not professional strippers pole-dancing for young men. "These were regular college girls. They didn't seem to be having fun," she said. "It was like, 'This is what we're supposed to be doing.'"

Gradus and Bauer, a writer for the Herald, then went on a research mission to a porn convention in Miami where "they were selling stripper poles to college girls and housewives," said Bauer. "There were so many mainstream women idolizing the porn stars and running after them to take pictures, and we were like, 'Whoa, this exists?'"

"We saw these girls embracing this idea that 'If I want to be like a porn star, it's so liberating,'" Gradus said. "We were skeptical. But it was such a broad concept. We asked, 'What is this shift in our sexual attitudes, and how do we define this?' I guess the common thread we saw that is creating this is technology.

"Technology being so available made every girl or woman capable of being a porn star, or thinking they're a porn star," said Gradus. "They're objectifying themselves. The thinking is: 'If I'm in control of it, then I'm not objectified.'"
PORN HISTORY
Porn is more available now than at any time in history-especially to kids. Ninety-three percent of boys and 62 percent of girls have seen Internet porn before they turn 18, according to a 2008 study in CyberPsychology & Behavior. Seventy percent of boys have spent more than 30 minutes looking at porn, as have 23 percent of girls. Eighty-three percent of boys and 57 percent of girls have seen group sex online. Eighteen percent of boys and 10 percent of girls have seen rape or sexual violence.

"Historically a spike in interest in pornography is associated with advancement in women's rights," said April Alliston, a professor of comparative literature at Princeton. She teaches a class on the history of pornography and has an upcoming book about porn, Consenting Adults: On Pornography, Privacy and Freedom (2013).

"What happened at the time of the invention of the printing press was very similar to what's happening now with the Internet," Alliston said. "With the printing press you had porn suddenly made available through technology. At the same time you had women getting more rights; there was more literacy and freedom for women. I see the spread of porn in part as a backlash to women's increased independence.

"I believe that porn has gone mainstream now because women have been gaining power. The feminist movement was somewhat successful. Rather than being about sexual liberation, porn is a form of control over sex and sexuality.

"It's become unfashionable to [take a negative view of porn] because of the reaction to the extreme anti-pornography views of [radical feminists] Andrea Dworkin and Catherine MacKinnon in the 90s. There was a reaction to their calls for censorship, and at the same time you had 'sex-positive feminists,' as they called themselves, saying porn is good, saying sex is the same thing as pornography, and seeming to imply that if we like sex, we like pornography too, which I think is equally extreme and incorrect.

"When it comes to children, there is really nothing to argue about," Alliston went on. "Kids are defined by our laws as not being able to consent to sex or to using pornography. There are few protections against them seeing it, and some people take the attitude that it's inevitable and benign. I think a lot of people who make this argument don't realize what porn today really looks like in terms of how the women are treated."
THE ANTI-DAPHNE MOVEMENT
"In the eighth grade, I had friend-it was a toxic friendship," said Daphne, now 19 and in college in L.A. "We got into a fight. I can't even remember what it was about-probably I had bought the same shoes as her or something. It got really bad, and one of her friends, a guy, decided to make a YouTube video starting an 'Anti-Daphne Movement.'

"Their goal was to get me to kill myself.

"It was, like, a 10-minute video. He showed a picture of me. He said my name. He recounted all the details of the fight. He said I was ugly and that I should kill myself. He told everyone on Facebook, 'I'm a member of this movement. If Daphne has ever done anything to you, post about it.'

"It caught on really fast. I had a lot of people writing really mean messages to me and deleting me as a friend [on Facebook]. I had never done anything to these people. At school they would put gross things in my bag, cottage cheese in my binder. It got over all my homework.

"It took three months before I got the courage to tell my dad. My dad got the school to get [the boy] to take the video down. The guy who did it didn't get in any trouble. The principal was friends with his mom. The principal said I must have done something bad for him to act that way, and I was actually suspended for a few days.

"I didn't know this boy at all. He was kind of a weird kid. People thought he was quirky and cool. He would say he was 'brutally honest,' but mostly he was just rude to people. I had to stay in the same school with him all through eighth grade. I went into therapy for what happened. It's made me so much more insecure. It's really hard for me to trust anyone."
THE SCENE GIRL
Amanda, 17, a senior at a high school in Santa Clarita, tried to kill herself last year. Her boyfriend of eight months had broken up with her so that he could play the field before graduating from high school-"he just wanted to live it up, was what he said"-and, after some months of turmoil, Amanda took an overdose of one of her mother's prescription medications. She was hospitalized briefly and is now in therapy.

She'd been slut-shamed on Facebook in ninth grade by a girl at her school, along with the girl's mother. "She"-the mother-"was saying I was a slut and all I do is lay on my back, but I've only been with one person," Amanda said. The police said nothing could be done about it because no direct threats were made.

Feeling isolated and depressed, Amanda got into drugs, ecstasy, and weed, and started hanging out with the Scene kids (kids into hard-core punk rock). "All I talked about was sex, drugs, money, and partying," she said. "I'd post pictures on Facebook of me smoking weed and partying."

When she started dating her boyfriend, with whom she went to school, she finally felt as if she had something to live for. "We were like the one couple that everybody knew, that everyone was like, 'You're so cute. You're gonna be together for a really long time.'" And now that she had a steady boyfriend, she was no longer called a slut.

But that ended all too soon. She attributes her boyfriend breaking up with her to the influence of his friends. "All his friends were like, 'Dude, you have a girlfriend. You can't do anything,'" meaning sexually, with other girls. And, Amanda says, he confessed that after breaking up with her, he did sleep with another girl.

"Boys have no respect for girls," Amanda said. "They'll be like, 'Damn, that girl's hot. I'd fuck her.'"
THE SEX EDUCATION OF JENNA: PART I
"One reason my boyfriend broke up with me senior year was that I was not a real person," said Jenna, 19, a college student in New York. She and her boyfriend dated online for two years after meeting at a beach resort where their families stayed when they were in high school. They communicated via Facebook, e-mail, and text. They met in person only twice. "I sat there and contemplated suicide when I heard he wanted to break up with me," she said. "I was like, 'What was the point of living?' I had given so much of myself to this person."

Jenna, a quirky beauty of the Zooey Deschanel variety, aspires to a job in the arts; her senior year in high school, she got a job working prefessionally in her chosen field. She friended a boy on Facebook, also an aspiring artist, who had already gotten some attention for his work. "I was like, 'Let's stick together and be friends and do this together,'" she said. They became good friends (in cyberspace). And then the boy developed feelings for her. But at the time Jenna was still dating her online boyfriend, so she declined the artist boy's online advances.

"After that, every time I would do any kind of status update on Facebook or post something on Tumblr or Instagram," she said, "he would comment on it, like, 'Jenna, you're not funny.'" Jenna often posted comical status updates; she thought of herself as a funny girl; she'd always liked to make people laugh. "He got everyone at my school"-a Manhattan magnet school-"in on it," she said. "His sister went there, so we knew a lot of the same people. Suddenly everyone was like, 'Jenna's not funny. She's stupid.' Everyone was posting mean comments about me, and he was egging them on. I saw him at a play at my school, and I asked him, 'Why are you doing this to me?' He said, 'Because, Jenna, you deserve it.'"

After that, she said, "I lost all my self-confidence. . . . And I realized in life there's only two ways for a girl to go, and that's to be a dumb bitch or just a bitch. I decided that from now on I'm just gonna be a bitch, 'cause at least from now on guys would be intimidated by me. At least I would have the upper hand. So from then on, if anybody ever tried to say anything to me, I would come back at them 30 times harder."
BREAKING UP IS HARDER TO DO
"So you broke up with your ex-boyfriend," said a freshman girl at a college in Manhattan; she was speaking hypothetically. "It's very sad. So of course he's not gonna want to see you in real life, so you wanna see him on Facebook. But then he defriends you on Facebook, so what do you do? You get your friend's account so you can stalk him. You check up on him on her account.

"But then he deletes your friend; he figures it out. So right now you have no connection to him, so what do you do? You create a fake account . . . call her [Jane Doe]. You literally Google 'brown-haired girl Instagram' and find a picture where you can't really see their face, but it's an actual person. You friend a bunch of his friends as [Jane Doe], add people from his family. Then you add his ex-girlfriends.

"What are they like? What are they into? What's the difference between them and me? Are they skinner than me? In their profile picture, they're in a bikini-they must be sluts, right? Maybe lesbians. And then finally after you have about 400 mutual friends, that's when you add him. This is so intelligent; it's like war strategy.

"You add some more pictures. You start a new persona. You start a new life, just so you can keep tabs on the person who doesn't want to ever speak to you again. Just so you can know he goes out to clubs all the time, and he's with this other girl. Why would you do it? Because it's an obsession. Social media breeds obsession."
SEX AND THE SOUL
What kind of love lives are teenagers headed for after they graduate high school? Sadly, more of the same, according to Donna Freitas, a former professor of religion at Hofstra and Boston Universities. Freitas's The End of Sex (2013) might as well be called The End of Love. The book studies hook-up culture on college campuses.

Much has been written about hook-up culture lately, notably Hanna Rosin's The End of Men (2012) and a July New York Times article, "Sex on Campus: She Can Play That Game Too," both of which attributed the trend to feminism and ambitious young women's desire not to be tied down by relationships.

But Freitas's research, conducted over a year on seven college campuses, tells a different story. "Both young women and young men are seriously unhappy with the way things are," she said. "It's rare that I find a young woman or a man who says hooking up is the best thing ever."

She describes the sex life of the average college kid as " Mad Men sex, boring and ambivalent. They drink like they're Don Draper to drown out what is really going on with them. Sex is something you're not to care about. The reason for hooking up is less about pleasure and fun than performance and gossip-it's being able to update [on social media] about it. Social media is fostering a very unthinking and unfeeling culture. We're raising our kids to be performers." And researchers are now seeing an increase in erectile dysfunction among college-age men-related, Freitas believes, to their performance anxiety from watching pornography: "The mainstreaming of porn is tremendously affecting what's expected of them." College kids, both male and female, also routinely rate each other's sexual performance on social media, often derisively, causing anxiety for everyone.

"The conversation that is missing is what rape is in hook-up culture," Freitas said. "These young women's sense of their own agency is incredibly detached. They tell me, 'And then I found myself in someone's bed having sex.' There's little actual choice or volition when you are drunk, and there is this expectation among everyone that if you are walking with a boy to your dorm room after a party, sex will necessarily happen."

And yet, with all the dangers for young women in hook-up culture, Freitas says, she's faced criticism from feminist colleagues for her take on it. "Big-time feminists won't go near hooking up because they look at it in theory as a sexually liberated practice," she said. "But I'm looking at it on the ground, talking to actual people, and it doesn't hold up as sexual liberation."
THE SEX EDUCATION OF JENNA: PART II
At the end of junior year of high school, Jenna met Ethan. "We were drunk, we hooked up," she said. "We saw each other again, drunk at another party, so we hooked up again, then we met at after-prom and hooked up 'cause we had hooked up before, and so it was comfortable and whatever."

And so began their non-romance. In fact, Jenna made it clear to Ethan that she didn't want "a Facebook relationship. There's people who have Facebook relationships where every day it's like"-typical status update, delivered in a singsong-"'Out to lunch with babe.' Kissy picture of this, kissy picture of that. Two weeks later, they're broken up. And then it's"-bitchy voice doing the status update-"' Certain people need to, like, stop stalking me on Facebook. Clearly we are never getting back together.' There's the Taylor Swifts and then there's the people who are just long-hair-don't-care. They just don't give a single fuck. They're just like, 'I'm gonna have sex with you.' 'I'm gonna have sex with you.' 'Hey, you're cute. I'm gonna have sex with you too if I want to.' They don't give a shit."

That, she told Ethan, was how it was going to be. "I told him it was just hooking up. I was so used to guys treating me like shit, I didn't want any guy to take advantage of me."

And Ethan took her words to heart. "He said, O.K., he wanted to hook up with other girls. And I was like, 'Sure, if you don't want to be in a relationship with me, I don't really care.' So I was like, 'Fine, I'll start hooking up with other guys.' So I would come to his house-no nonsense, clothes off, let's do this, get into my bed. And we would hook up every couple days; it started being a casual thing."

This went on for about a year. "We were friends with benefits," Jenna said. "Sometimes we wouldn't even talk that much. I'd just be like, 'I'm coming over,' and then I'd go over and we'd sleep together and then I'd leave."

Even when Ethan, drunk at another party, admitted to Jenna that "I think of you as my girlfriend," she told him, "'I would never, ever in my fucking life be your girlfriend.' Immediately his face fell and he walked away, and after that we were pretty mean to each other."

They still continued hooking up. And then, last spring, Jenna's grandfather died, and Jenna was furious with Ethan when he didn't reach out to console her. "I finally texted him like, 'My grandfather died and you have nothing to say to me? And I've been sleeping with you for a year?' And his response was, 'So I really just don't see why you said I could never be your boyfriend.'"

She smiled.

"So we realized we were being super stupid, and I was like, 'Do you want to be in a relationship? What do you want?' And he was like, 'I really love you. I've never met anybody like you. You're not a dumb bitch.'

"So now we're together."

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What Facebook, Twitter, Tinder, Instagram, and Internet Porn Are Doing to America's Teenage Girls

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NOTE: Some of the names and identifying details in this story have been changed. THE TINDER GUY She wanted it to be like the scene in the Lana Del Rey video for "Blue Jeans"-"hot and slow and epic."

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Lecture Information on Sexual Relationships

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Lecture Information on Sexual Relationships

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Social-Ecological Perception of Vulnerable Youth

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Social-Ecological Perception of Vulnerable Youth

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Teen pregnancy rates are among the lowest in the world, due to the provision of comprehensive sex education that does not depict sex as a 'forbidden act', but part of the teen experience. The Netherlands do shy away or create stigma on the topic, which has somewhat contributed to this low rate. While this media source is not credible, the Statistics Netherlands report this article is based on is a credible source.

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The number of Dutch teenage mothers is unprecedentedly low according figures released by Statistics Netherlands.

Last year, 2.2 thousand girls under the age of 20 gave birth, i.e. less than 1.5 percent of all births registered in the Netherlands. The number of teenage births has never been this low. Teenage births still frequently occur among Antillean and Surinamese girls.

Since 2011, fewer than 5 per thousand 15 to 19-year-old girls give birth. With 4.5 thousand, last year's teenage birth rate was the lowest ever recorded by Statistics Netherlands. Around 1970, the teenage birth rate was still nearly five times as high.

One of the lowest birth rates in the world
The birth rate among teenagers in the Netherlands is one of the lowest in the world. In Europe, only Switzerland and Denmark have lower rates. The low rate is predominantly due to pregnancy prevention. Abortion rates in Switzerland and the Netherlands are relatively low. In Denmark, abortions among teenage girls are much more frequent. The highest birth rates are found in Bulgaria and Romania and the United Kingdom.

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Dutch teen pregnancy rate among lowest in the world

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The number of Dutch teenage mothers is unprecedentedly low according figures released by Statistics Netherlands. Last year, 2.2 thousand girls under the age of 20 gave birth, i.e. less than 1.5 percent of all births registered in the Netherlands. The number of teenage births has never been this low.

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This journal article mentions healthy and unhealthy and social ecologies and may be used to describe why teens get involved in risky sexual behaviour. It is peer reviewed and a credible source highlighting the works of Urie Bronfenbrenner

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WANTED: A REALISTIC ATTITUDE TOWARD TEEN SEX

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WANTED: A REALISTIC ATTITUDE TOWARD TEEN SEX

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This news article provides a comparison between attitudes towards teenage sexual behaviour in European countries such as the Netherlands and France, versus those in the USA. It concludes that countries more open about teenage sex correlated to a lower teen birth rate, lower diagnosis of STI's and a lower rate of abortions. While not credible, it shows that an open attitude to sex could make a difference to negative outcomes.

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Here are some eye-popping new numbers that deserve the attention of everyone concerned about the health, welfare and future of our young people. In France, a country long celebrated for its exuberant open-mindedness about sex, nine out of 1,000 women between the ages of 15 and 19 give birth. In Germany, it's 13 per 1,000, and in the Netherlands, which may be the most sexually liberated of all three, the figure is seven per 1,000. Contrast those numbers with the United States, where Puritanism is making a comeback, and teen sexuality has become a political football in the culture war. Our rate is 54.7 per 1,000. That's eight times the rate in the Netherlands. And to head off the obvious riposte from the wowsers, the difference is not because their girls have more abortions. Quite the contrary. In the Netherlands, the abortion rate is a third of ours; in France, it is half. Need more numbers to suggest that there is something badly wrong with our attitudes toward young people and sex? Look at AIDS statistics, and you see the same picture. The rates of AIDS reported per 1,000 teenagers and adults is 0.75 in France, 0.20 in Germany and 0.28 in the Netherlands. It's 2.33 in the United States. Why are these countries able to do such an effective job of protecting their teenagers? A team of 40 public health researchers and two teenage journalists visited the three countries to find out. The study tour -- sponsored by Advocates for Youth and the University of North Carolina at Charlotte -- was the first to explore all of the sociological, cultural and community factors that influence teen sexual behavior, according to Barbara Huberman, director of sexuality education for Advocates for Youth. Huberman has studied adolescent sexuality for 30 years. "One of the key things we found out that was new to me," she says, "was in spite of the liberalness of sexuality being present in the community . . . their teenagers don't start having sex until a year or two years later than ours." This, of course, flies in the face of the argument that dispensing information about sex and healthy sexual practices promotes promiscuity. A French teenage boy told her that the American attitude turns sex into forbidden fruit, which simply entices our youngsters to try it. But in France, where sexual activity is considered a normal part of young people's development, there is widespread information about sex, about how to protect against pregnancy and disease and about how to make responsible decisions. As a result, this young man told her, using contraception to him was almost a reflex. "We are the only industrialized country in the Western world with an official government abstinence program, and we have the highest rates of teenage pregnancy, HIV and sexually transmitted diseases," says James Wagoner, president of Advocates for Youth. "The Netherlands has the most liberal approach, and it has young people who start later and have fewer sexual partners." Our young people become sexually active on average at 15.8 years of age -- when they are still children. In the Netherlands, the figure is 17.7 -- when they are almost adults. Teenage condom use is about the same in all four countries, but in the Netherlands, nearly 67 percent of teenage girls use oral contraceptives, while in the United States only 20.5 percent do. National health care in the three European countries covers the cost of contraception, emergency contraception, abortion, counseling, physical exams and treatments. Contraception is readily available without gynecological exams. The researchers found that in all three countries, a major public health goal is to ensure that all sexually active people have the skills to behave responsibly. The mass media have become partners with public health officials in putting together public information campaigns that encourage specific healthy behavior but avoid bombarding people with fear or shame. The campaigns run throughout the day. Great value is placed on individuals behaving ethically about sex,and that attitude is transmitted to young people. Sexuality-related public health policies are driven by scientific research, not politics or religion, even though the Roman Catholic Church is a powerful institution in both France and Germany. "We were told by one Frenchman, We have true separation of church and state,' " Huberman says. " You think you do, but you don't.' " Much of the push in France and Germany for realistic policies to curb teenage pregnancy came from the church's opposition to abortion, she says, and a recognition that the best way to do that was to promote contraceptive use. News flash. Meanwhile, the United States is going in the opposite direction. The 1996 welfare reform legislation forbids any federal money from being used to give out information about contraception or condoms for preventing pregnancy or sexually transmitted diseases. Advocates for Youth is hoping that by getting the information out about what works -- an effort that began with a symposium on Capitol Hill yesterday -- it can make a case for changes that will protect sexually active young people. "American parents want to hear what works," Wagoner says. The Dutch view their young people as assets, not liabilities, he says. In all three countries, researchers found that young people were respected, that adults believed they had rights to information and services that would promote sexual health, and that they were expected to act responsibly. If we can ever get rid of our Puritan roots and become sane and realistic about sex, those three R's would be good core values on which to build public policies that work.

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WANTED: A REALISTIC ATTITUDE TOWARD TEEN SEX

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Here are some eye-popping new numbers that deserve the attention of everyone concerned about the health, welfare and future of our young people. In France, a country long celebrated for its exuberant open-mindedness about sex, nine out of 1,000 women between the ages of 15 and 19 give birth.

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An opinion article on teenage sexual behaviour. 'Their capacity for managing emotions and making good judgments continues to develop into young adulthood' notes child psychiatrist Stephen Grcevich. As this is an opinion article it is not credible, but gives and idea of some attitudes people hold about teenage sex.

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STEPHEN GRCEVICH
Chagrin Falls, Ohio, July 24, 2011
The writer is an associate professor of psychiatry at Northeast Ohio Medical University.

To the Editor:
As a pediatrician and the mother of a 16-year-old daughter, I found that "The Sleepover Question" reinforced what I have found to be true in my practice and personal experience. American parents are deluding themselves if they think that preventing a boyfriend from spending the night in their daughter's bedroom precludes sexual intimacy. Rather, what it does do, too often, is preclude the use of contraceptives.

Countless times I have had girls confide to me that their parents "would kill" them if the parents found out that they were having sex. These same young women are the ones who often admit that they are not using birth control. The rare teenager whose parent is not clueless turns out to be the one who is practicing safe sex.

Condoms should be used to prevent sexually transmitted diseases, but I have found that consistent condom use is also correlated with more openness about sexual activity. If a parent finds a condom wrapper, the girl knows that her illicit activity will be discovered.

The involvement of a parent (virtually always the mother) makes getting contraceptives much easier. It is far easier to obtain birth control pills when a girl does not have to schedule her own appointment, go to the pharmacy herself and then hide the packet where no one will see it.

American parents need to wake up and realize that if teenagers want to have sex, they are going to find a time and a place to have it. Pretending otherwise is just increasing the risk that the sexual activity will have unwanted consequences.

R. LISA BERNARD
Los Altos, Calif., July 24, 2011
To the Editor:
Amy Schalet asks us to compare American "cultural ideas" and those prevalent in the Netherlands when determining a parental response to teenage sexual activity "under my roof." While her discussion hinges on sexual mores, I recall seeing the social destruction wrought by the infamous Needle Park in Amsterdam and its storefront red light district as other examples of the Dutch model of "divergent cultural ideas."

Different ideas are not always better ideas.

JAMES M. BOLING
Richland, Ga., July 28, 2011

Correction: August 3, 2011

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Opinion | American Attitudes Toward Teenage Sex

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STEPHEN GRCEVICH Chagrin Falls, Ohio, July 24, 2011 The writer is an associate professor of psychiatry at Northeast Ohio Medical University. To the Editor: As a pediatrician and the mother of a 16-year-old daughter, I found that "The Sleepover Question" reinforced what I have found to be true in my practice and personal experience.

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This article examines the media's role in influencing sexual behaviour in teenage years. It is not recent (2000) and may not be credible, but provides an insight into how the media can influence the behaviour of young people.

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This article by the Centers for Disease Control and Prevention (USA) provides a definition of the term 'risky sexual behaviour' and what behaviours are included under this term. It also provides statistics on risky sexual behaviour of young people in the United States from 2010. It is a credible source; a government study conducted by professionals.

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Youth Risk Behavior Surveillance --- United States, 2009

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YRBSS is the largest public health surveillance system in the United States monitoring a broad range of health-risk behaviors among high school students.

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This study conducted in 2014 can be used to compare adult sexual behaviour statistics to those already collected regarding teens. It is a credible source

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Australian Statistics on adolescent sexual behaviour

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Australian Statistics on adolescent sexual behaviour

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Government statistics on teenage sexual issues. This is a credible source.

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Unsafe sex practices and unwanted pregnancy are significant health issues for Australian teenagers. The bulk of the information in this article was taken from the 2002 results of the third National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health, carried out by the Australian Research Centre in Sex, Health and Society and funded by the Commonwealth Department of Health and Ageing.

Sexual activity and teenagers

Most young people in Years 10 and 12 are sexually active to varying degrees. Selected statistics include:

About one in four Year 10 students and half of all Year 12 students have had vaginal intercourse.

Of the young people who had ever had sex, about half of the males and 61% of the females had at least one sexual partner in the last year.

Between 15% and 19% had two sexual partners in the last year.

37.3% of Year 10 students and 56.7% of Year 12 students have engaged in oral sex.

The most recent sexual encounter for about two thirds of young people was with their regular girlfriend or boyfriend.

The most recent sexual encounter for 10.8% of teenagers was with someone they had met for the first time, with higher figures for males (18.1%) than females (4.6%).

Students in Year 10 are more likely to have had their most recent sexual encounter with someone they met for the first time (15%) than students in Year 12 (7.6%).

Sexual attraction and teenagers

Selected statistics on sexual attraction include:

Most young people (93%) reported attraction to members of the opposite sex.

4.6% are attracted to both sexes, with less than one per cent stating they are solely interested in same sex partners.

Males are more likely to report same sex attraction, while females are more likely to report attraction to both sexes.

About 2% of the most recent sexual encounters at the time of the survey were with a person of the same sex.

Preferred forms of contraception

Selected statistics on the form of contraception used at the most recent sexual encounter include:

Condoms - 64.4%

The pill - 36.8%

Withdrawal - 11.8%

No contraception used - 9.4%

Contraception - common issues for teens

Contraception issues for young people include:

A New South Wales study found that 86% of young people in relationships of one year's duration or less don't use condoms every time they have sex.

Over half of those who use the contraceptive pill don't use condoms to protect themselves from sexually transmissible infections (STIs).

About 50% of teenagers are sexually active for 12 months before they visit their doctor for prescription contraception.

Around half of all teenage pregnancies occur within the first six months of becoming sexually active.

Young people are the most common users of the morning after pill at Australian family planning clinics.

Statistics from 1998 show that medical abortion is the second most common hospital procedure for Australian women aged between 12 and 24 years.

According to Medicare records from 1997 to 1999, there were 22 abortions per 1,000 teenagers, which is one of the highest teenage abortion rates in the West, following USA, Hungary, New Zealand, United Kingdom and Canada.

Safe sex for teens

Most teenagers aren't practising safe sex. Selected statistics include:

One in four teenagers have had sexual intercourse without using a condom.

Only 40% of Year 12 students always use condoms.

Of Year 12 students, males are more likely to report using condoms (52.2%) than females (34%).

One in four teenagers report they were either drunk or high during their most recent sexual encounter.

Estimates suggest that about 28% of Australian teenagers may be infected with chlamydia.

Sexual confidence and teenagers

Selected statistics include:

Most young people feel confident they can deal successfully with issues such as unwanted sex or a partner who is unwilling to use a condom.

Most young people don't feel confident they can talk about sexual issues such as contraception with their parents.

Most young people (68.8%) talk to their partner about condom use before they have sex.

Prior discussion with a sexual partner about other sexual issues is uncommon; for example, only 23.6% of young people talk with their partners about how to reduce the risk of STIs.

22.8% of young people didn't discuss any sex-related issues, such as condom use and avoiding pregnancy or STIs, prior to their most recent sexual encounter.

Unwanted sex and teenagers

Over one in four teenagers had experienced an unwanted sexual encounter. Selected statistics include:

5% of teenagers reported that their most recent sexual experience was unwanted.

15.9% experienced unwanted sex because they were drunk, with higher figures for females (17.6%) than males (13.9%).

6.1% experienced unwanted sex because they were using recreational drugs, with higher figures for males (6.9%) than females (5.4%).

12.6% experienced unwanted sex because they were pressured by their partner, with higher figures for females (13.9%) than males (11%).

2% experienced unwanted sex because they were pressured by their friends, with higher figures for males (2.9%) than females (1.2%).

Where to get help

Your doctor

Kids Helpline Tel. 1800 551 800

Parentline Tel. 132 289

Family Planning Victoria Tel. 1800 013 952 or (03) 9257 0100

Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619

Marie Stopes Tel. 1800 003 707

Things to remember

Most young people in Years 10 and 12 are sexually active to varying degrees.

One in four teenagers report they were either drunk or high during their most recent sexual encounter.

Most teenagers do not practice safe sex.

Content Partner

This page has been produced in consultation with and approved by: La Trobe University - Australian Research Centre in Sex, Health and Society

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.

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Unsafe sex practices and unwanted pregnancy are significant health issues for Australian teenagers. The bulk of the information in this article was taken from the 2002 results of the third National Survey of Australian Secondary Students, HIV/AIDS and Sexual Health, carried out by the Australian Research Centre in Sex, Health and Society and funded by the Commonwealth Department of Health and Ageing.

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This web article summarises and provides statistics on trends regarding adolescent sexual behaviour. The research in peer reviewed and is therefore a credible source.

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Research has also begun to highlight an alarmingly high rate of involuntary sex among young people. In the 1995 National Survey of Family Growth, 13% of 15-19-year-old females reported that they had been forced to have sex.When asked about their first sexual experience, 22% of 15-44-year-old women for whom it occurred before age 15 reported that the act was involuntary, as did 16% of those who first had sex before age 16. Involuntary sexual activity is typically unprotected and thus puts its victims at very high risk of pregnancy and STIs.

Finally, recent research and clinical observations suggest that a substantial proportion of teenagers, including those who report having never had vaginal sex, are engaging in oral sex. This trend has negative implications for teenagers' sexual health because many seem unaware that STIs can be acquired through unprotected oral sex.

Adolescent health professionals are faced with the dilemma of how to refine programmatic and research efforts to maintain the progress that has been made while reducing those risk behaviors that remain too prevalent. The solution may lie, in part, in bridging the gap between research and programs. For more than 30 years, researchers have studied the antecedents of teenagers' high-risk sexual behaviors, and service providers have designed programs to prevent those behaviors. Their efforts have typically proceeded independently, however, and each professional community's work has not routinely informed that of the other. This lack of communication is understandable, given the differences in professional backgrounds and training, work settings and day-to-day activities. We believe, however, that this lack of communication inevitably compromises the quality of both research and programs related to teenage sexual health and behaviors.

We are an interdisciplinary group of public health researchers and service providers who are committed to bridging the chasm between research and programs. In this comment, we suggest ways in which work to reduce levels of teenage pregnancy and risk-taking can proceed in a more integrated and collaborative fashion. We believe that research on prevention should be designed and conducted to inform the development of programs and policy. The issues that emerge as these programs and policies are implemented, in turn, will raise questions that promote further research, which ultimately will inform the next generation of programs and policies.

The structure of this comment models this process. We begin on the research side and give a brief overview of findings on the antecedents of adolescent sexual risk behaviors and pregnancy, and discuss their implications for program and policy development. This effort is grounded in a comprehensive literature review that we conducted for the Centers for Disease Control and Prevention (CDC).* We then move to the program side. On the basis of our own clinical observations and discussions with other providers in a variety of settings, we identify a set of critical programmatic issues that hinder success in reducing adolescents' sexual risk-taking. Finally, we outline the specific research questions raised by these service-related issues. The answers to these questions will potentially enhance program efficacy.

RESEARCH SIDE

Antecedents of Risky Sexual Behaviors and Pregnancy

In our literature review for the CDC, we targeted three risky sexual behaviors-early onset of sexual activity, nonuse of contraceptives and nonuse of condoms-and one possible outcome of those behaviors, teenage pregnancy. Major literature reviews on these topics were published in 1987 and 1995; we supplemented and updated them by systematically examining the research published in peer-reviewed journals from 1994 to 2002.

The literature identifies four key sets of factors that have been associated with risky sexual behaviors and pregnancy: race and ethnicity; socioeconomic status; social influences; and attitudes toward contraception, condoms and pregnancy and safer-sex behavioral skills. Differences by race and ethnicity vary across risk behaviors. For example, black teenagers are more likely to have very early vaginal sex than Hispanics, who are more likely to do so than whites. (Specifically, black males initiate vaginal sex more than two years earlier than Hispanic males, and three years earlier than white males.) Hispanic adolescents are the least likely to have used a condom or another contraceptive method at last intercourse. The combined influences of earlier sexual debut among blacks and greater nonuse of contraceptives among Hispanics yield higher teenage pregnancy rates among nonwhite than white teenagers.

These racial and ethnic differences in sexual risk-taking and pregnancy are partly attributable to differences in socioeconomic disadvantage. More broadly, socioeconomic status is related to each of the four outcomes studied. Among the socioeconomic indicators that significantly predict risky sexual behaviors and pregnancy are the adolescent's having a parent with low educational attainment and living in a single-parent family. A teenager's own level of academic achievement is positively related to age at sexual debut.

Sexual risk behaviors are also related to attitudes and behavioral skills. Adolescents' attitudes toward practicing contraception, using condoms and becoming pregnant predict the likelihood that each will occur. In addition, their specific attitudes toward pregnancy affect the likelihood that they will practice contraception and use condoms. Furthermore, teenagers who feel they have the requisite skills to use condoms (i.e., they can obtain them and successfully negotiate their use with a partner) are more likely than others to use condoms. Similarly, young people who have demonstrated to themselves that they can use contraceptives (i.e., they used them once) are more likely than others to use them again.

Programmatic Implications of the Research

Taken together, these research findings have implications for programs that are designed to reduce high-risk behaviors among adolescents. The programmatic implications yield the following eight broad recommendations.

*Programs should begin earlier and target younger adolescents. Since adolescents who experience early puberty are at increased risk for early sexual activity, primary health care providers should be screening and counseling youth regarding puberty, sex and sexual risk behaviors at younger ages than they currently do. Many young adolescents receive health care from pediatricians or family practice physicians; these health professionals should inquire about each patient's sexual experiences and intentions during preadolescence and early adolescence. They then should provide developmentally appropriate educational and counseling messages that are responsive to the young person's stage of sexual activity. Because at least some young people have oral sex before vaginal sex, it is important that these conversations include oral sex.

*New program models for minority teenagers need to be developed. The data documenting the early onset of vaginal sex among black males and the relatively low levels of contraceptive and condom use among Hispanic teenagers suggest that current prevention models are ineffective at reducing these behaviors in nonwhite communities.

*Risk reduction programs need to be systematically linked to other youth programs that directly address socioeconomic disadvantage. The literature paints an overall picture of heightened risk among poor and disadvantaged adolescents. Programs that address sexual and reproductive health issues in disadvantaged communities tend to offer a vital but limited array of services. With some notable exceptions (e.g., the Children's Aid Society-Carrera Program), these programs have not addressed the fact that poor teenagers' motivation to avoid pregnancy is undermined by their blocked opportunities for advancement.

We recognize that it is both difficult and costly to incorporate vocational and academic counseling and support, as well as mentoring and related services, into sexual and reproductive health programs. Rather than attempt to provide these important services, sexual risk reduction programs could form active partnerships with youth programs that are focused on these other goals. Such partnerships would connect teenagers to a supplementary web of services as well as increase the level of coordination between a wide array of youth organizations and providers.

*Programs need to understand that many youth lack the skills to practice safer sex. A variety of behavioral skills are necessary for condom use, including communication, negotiation and refusal skills, and technical condom use skills. Programs must train clients in these skills and provide time and a comfortable place for them to practice. While the resource investment needed for such skills training may appear to be beyond the normal scope of adolescent health and family planning programs, ignoring this component undermines the value of safer-sex education and counseling.

*Programs need to effectively address the influence of peer groups, social norms and pressures to have sex. The influence of social norms is particularly acute during adolescence, which is characterized by a strong need to fit in with one's peers. Small-group interventions to address these pressures are particularly promising, since these programs offer a unique opportunity to develop and reinforce norms that support risk reduction behaviors. Over time, the group becomes a valued social network that motivates adherence to the newly formed norms. Some group interventions have been set up with preexisting friendship networks; this approach takes advantage of natural social networks that then can reinforce the normative and behavioral change after the intervention ends.

A small-group program will only be effective, however, if the intervention lasts long enough for the group to coalesce and function as a valued social network. Decisions on program duration thus need to take into account not only the time involved in knowledge acquisition and skills training, but the time needed to create a cohesive group that can generate and support new norms.

*Programs for adolescents should not assume that sexual behavior is volitional. Despite the overall high rates of forced sex reported by young women and the high proportion of very early sexual activity that is reported to be involuntary, most current models of sexuality education and counseling assume that youth are free agents in their sexual decision-making. Thus, when programs counsel about abstinence or safer sex and teach the requisite skills to practice them, the desired behavior is expected to follow. However, this assumption misses the mark for youth who are unable to make autonomous decisions about whether and under what conditions to have sex.

The starting point is to develop protocols that sensitively elicit information from youth about whether their sexual activity is voluntary. This would involve training providers to feel comfortable seeking this information. The next step is to link youth who report nonconsensual sex to counselors who have been trained in working with young people on this issue.

Ideally, social workers should be added to the staff of family planning clinics and pregnancy prevention programs so they can intervene with youth who have had early nonconsensual sex. For this group of very high-risk youth, social work intervention is a necessary supplement to traditional family planning education and counseling. Programs that do not and cannot provide mental health services need to design a referral system that is suited to adolescents. Because clinical experience has shown that adolescents given a referral will not always make and keep an appointment, the system should test new methods of making and following up on adolescent referrals.

*Programs should not assume that sexual activity among teenagers is limited to vaginal sex. If substantial proportions of youth view behaviors aside from intercourse as safer forms of sexual activity than vaginal sex, it is important that programs explicitly discuss these behaviors and educate youth about them. Adolescents need to know about the risks for STIs associated with oral and anal sex, as well as how to protect themselves from these infections.

*Programs cannot assume that teenagers are unambivalent about preventing pregnancy. For many adults, the issue is perfectly clear-teenagers should not bear children. However, it is incorrect to assume that teenagers, particularly those who are most at risk of early childbearing, share this view. Teenagers hold a range of attitudes toward childbearing; while the more negative attitudes along that spectrum protect against early pregnancy, the more positive ones increase the risk of unprotected sex. In-depth studies on these attitudes indicate that although few teenagers want to become pregnant in the near future, a sizable minority are ambivalent about that prospect. Teenage pregnancy prevention programs need to focus more on this ambivalence, which, if left unchecked, affects adolescents' motivation to delay sex or to use contraceptives consistently.

Innovative programs that probe adolescents' attitudes toward childbearing should include values clarification exercises and discussions that reality-test young women's beliefs about childbearing, particularly the likely role of the baby's father in their lives and in the baby's life. Such programs may be offered in a variety of settings, including health education classes and after-school recreational programs, and through videos shown in the waiting rooms of adolescent health, school-based health or family planning clinics.

PROGRAM SIDE

In our clinical observations and discussions with an array of service personnel, providers identified four key issues as impediments to program success with adolescents. Each of these translates into a set of questions to help guide research. Because these questions are grounded in concerns brought up by program providers, the research undertaken to answer them is likely to be embraced by providers in their continuing efforts to improve the quality of prevention programs.

Learning Disabilities and Cognitive Immaturity

The link between poor academic performance and high-risk sexual behaviors is well established. While many variables contribute to academic failure, we focus on cognitive deficits, which include learning disabilities and cognitive immaturity.

Through our clinical practices and program work, we have come to believe that teenagers with cognitive deficits probably engage in early, unprotected sexual activity at higher rates than others do. These deficits may cause low academic achievement, which in turn increases the likelihood of sexual risk-taking. Our observation is supported by a study based on data from the National Longitudinal Survey of Youth, which documented a significant association between low cognitive ability and early childbearing. Practicing safer sex requires a series of skills and abilities (i.e., abstract thinking, cost-benefit analysis, anticipatory planning and behavioral control) that may be lacking in youth with learning disabilities or low levels of cognitive maturity.

Finally, cognitive deficits may result in sexual risk-taking because sexuality education and pregnancy prevention programs are not designed to accommodate the learning styles of these children. Educational research and theory clearly indicate that effective teaching requires sensitivity to the learning style, as well as the cognitive ability and maturity, of the learner. This theory, however, has not filtered into the fields of health education and communication. Adolescent counseling and education programs are typically designed with a one-size-fits-all approach. This standardization of teaching mode and content places teenagers with learning disabilities and low levels of cognitive maturity at a clear disadvantage.

Research is needed into the association between learning and related disabilities (e.g., attention deficit disorder), cognitive immaturity and sexual risk-taking behavior among adolescents. Our experience suggests that such research needs to address the following questions:

*Are adolescents with learning disabilities and low levels of cognitive maturity at greater risk than their peers for sexual risk-taking and poor sexual health?

*Can screening instruments for assessing learning disabilities and cognitive maturity be adapted for use by providers in clinical settings?

*Are specific types of instruction, counseling, support and follow-up more effective than others in reducing sexual risk-taking among cognitively impaired adolescents?

Insufficient Male Involvement

The majority of adolescent pregnancy prevention programs have been designed for females, partly because women are the ones who get pregnant and because, except for condoms, all reversible contraceptive methods are female methods. However, the strength of the rationale for focusing exclusively on women has diminished over the last few decades. For example, a heightened concern with preventing disease as well as pregnancy has made males an increasingly important audience for programmatic efforts. Among adolescents who are sexually active, the most effective method of disease prevention is the male condom, which reinforces the need to include young men. Finally, increased interest in delaying the onset of sexual activity has meant that prevention programs need to be directed at both sexes.

Typically, programs that involve young men have "budded off" of existing programs for women. Such a secondary focus is unlikely to be the best approach to serving young men, however. The guiding question is how to best design and structure clinical programs that focus on young men and contribute to global pregnancy and disease prevention goals. Systematic research into this area should address the following:

*What is the most appropriate setting for male sexual health programs-stand-alone efforts or interventions that are part of larger family planning and sexual health programs that serve women as well?

*What are the most appropriate services for male programs: Would young men be more comfortable if the program also provided primary health care services rather than sexual health services exclusively?

*What is the most appropriate content for counseling and health education for males, and what strategies would best deliver that content?

*Do male clients feel more comfortable with male providers than with female providers?

*How do we change the generalized belief among the public and providers alike that only young women, and not young men, need reproductive and sexual health services?

Males' Very Early Sexual Activity

In recent years, considerable attention has been paid to very early onset of vaginal sexual activity among females (i.e., before age 14), particularly because unacceptably high rates of nonvolitional sex have been documented among this age-group. We know little, however, about the nature or context of males' very early vaginal sex. The issue is most pressing for black males, whose median age at first sex is 13.6 years. The most extreme explanation for this finding is that young males are frequently coerced into having vaginal sex. However, even if such sexual activity is not physically forced, it may not be truly voluntary. One factor motivating early intercourse may be that male peer group norms endorse early sex as a way to prove masculinity and thus solidify social standing. Knowing the motivation behind and nature of early sexual experiences among young men is critical for designing counseling and educational programs that are grounded in the reality of their lives. Research is needed to address the following questions:

*To what extent is very early vaginal sex voluntary for young men?

*What is the age difference between young men who are pressured to have sex and their partners?

*Even when early sex is not forced, is it a response to peer group pressures or other social influences?

*How do these young men feel about their very early sexual activity?

*What factors protect against very early onset of sexual activity among males?

Onetime Program or Clinic Visits

For many of the health professionals who are best positioned to provide risk reduction services to youth, the onetime visit poses an enormous obstacle. Clients of adolescent health, school health and family planning clinics, which serve large numbers of youth, typically make a single visit, followed by an indeterminate interval before a second one. Program staff need to somehow effectively provide risk reduction education and counseling in a single visit, and also offer the service that the client came for. The reality of health care financing, with its premium on short visits, compounds this problem.

The dilemma of the single visit is complex, and little research exists on how best to address it. Clearly, providers need to make the most creative use of their limited time with adolescent clients. One idea is to use the waiting room as a forum for health education. Adding a health educator to clinic staff can transform the waiting room from a source of frustration and boredom into a site for receiving health education, participating in discussions about sexual risk-taking, and learning sexual communication and refusal skills. Waiting-room health education can be facilitated by the use of culturally and developmentally appropriate videos and slide shows or print material to spark discussion between the client and educator. Computers with interactive educational software may also be used for health education and counseling.

Another possibility is to extend contact with adolescent clients through follow-up by phone or e-mail. These contacts could be initiated by a trained counselor or health educator as a way of staying in touch; they could also be used to reinforce counseling and educational messages that were presented at the clinic and to encourage a revisit.

The development of these new approaches will take time and money. Both will be hard to come by in a period of shrinking resources in which understaffed and underfunded providers are overwhelmed. These new efforts must therefore be conducted with external funds that include evaluation monies. Research to identify the most feasible and effective models for extending the one-visit encounter and maximizing its impact should be guided by the following questions:

*What are the goals of waiting-room education, and are programs successful at achieving them?

*What are the minimum requirements for a waiting-room program to be successful?

*Is waiting-room education most effective when it is led by an educator, or are electronic media presentations (i.e., via video or computer) just as effective?

*Are periodic phone or e-mail contacts effective at reinforcing health education messages about safer sex? Do they help maintain gains in knowledge and changes in attitudes and behaviors?

* Do follow-up contacts work best for particular groups of adolescents?

CONCLUSIONS

Our goal was to suggest ways in which research and programs could work in a more integrated and collaborative fashion. An attempt to forge links between research on the antecedents of high-risk behaviors and risk reduction programs led us to recommend new criteria to guide that research. The three criteria usually used to identify antecedents of risk-taking and assess their importance are theory, precedence in the literature, and statistical significance and relative magnitude of the variable's effect. Researchers select antecedents to evaluate on the basis of the first two criteria, and make empirically based conclusions about their impact on the basis of the third. We recommend that the tractability and program relevance of antecedents be added to the list of criteria.

Sometimes antecedents that are very potent but relatively immutable may ultimately be less important than factors that are less strong but more amenable to change or that have clear implications for program development. Researchers need to achieve a better balance between focusing on factors that will help them best model or extend theory on risk behaviors, and focusing on factors that can best inform programs and policy on these behaviors.

Careful consideration of the four critical issues that emerged as obstacles to successful risk reduction programs may provide a road map for a more collaborative engagement between program providers and researchers. To date, many providers have perceived research on the determinants of adolescent sexual risk-taking and pregnancy as external to their needs and perspectives. This detachment may help explain why program people do not openly embrace such research. We suggest that research steeped in the concerns articulated by providers will yield more provider buy-in. This, in turn, will enhance the likelihood that providers will use study findings to develop and modify risk reduction programs for youth.

We hope that the process outlined here extends the research agenda by encouraging studies that are explicitly attuned and responsive to programmatic issues. The primary goal of such research is not to expand theory or increase knowledge (although it may well do so). Instead, the goal is to translate programmatic issues into research questions, whose answers will enhance the development and quality of sexual risk reduction policies and programs. Such programmatic research is a vital supplement to basic research on reproductive and sexual health, and will fundamentally strengthen the tenuous linkages between the research, program and policy communities.

Footnotes

* The literature review, which contains a detailed section on study methodology, is available from the first author.

† Some examples of adolescent clinical programs that have adopted this comprehensive approach are the adolescent family planning and school-based health clinics run by the Mailman School of Public Health and the Center for Community Health and Education in collaboration with New York Presbyterian Hospital, the Mount Sinai Adolescent Health Center and Planned Parenthood of New York City.

References

Abma JC et al., Fertility, family planning and women's health: new data from the 1995 National Survey of Family Growth, Vital and Health Statistics, 1997, Series 23, No. 19; Ventura SJ et al., Births to teenagers in the United States, 1940-2000, National Vital Statistics Reports, 2001, Vol. 49, No. 10; and Sonenstein FL et al., Changes in sexual behavior and condom use among teenaged males: 1988 to 1995, American Journal of Public Health, 1998, 88(6):956-959.

3. Ibid.

7. Abma JC et al., 1997, op. cit. (see reference 1).

Schuster MA, Bell RM and Kanouse DE, The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse, American Journal of Public Health, 1996, 86(11):1570-1576; Gates GJ and Sonenstein FL, Heterosexual genital sexual activity among adolescent males: 1988 and 1995, Family Planning Perspectives, 2000, 32(6):295-297 & 304; and Remez L, Oral sex among adolescents: is it sex or is it abstinence? Family Planning Perspectives, 2000, 32(6):298-304.

12. Abma JC et al., 1997, op cit. (see reference 1); and Sonenstein FL et al., 1998, op. cit (see reference 1).

13. Abma JC et al., 1997, op. cit. (see reference 1).

Miller BC et al., The timing of sexual intercourse among adolescents: family, peer and other antecedents, Youth and Society, 1997, 29(1): 54-83; Billy JO, Brewster KL and Grady WR, Contextual effects on the sexual behavior of adolescent women, Journal of Marriage and the Family, 1994, 56(2):387-404; Brewster KL, Race differences in sexual activity among adolescent women: the role of neighborhood characteristics, American Sociological Review, 1994, 59(3):408-424; Capaldi D, Crosby L and Stoolmaker M, Predicting the timing of first sexual intercourse for at-risk adolescent males, Child Development, 1996, 67(2): 344-359; Lauritsen J, Explaining race and gender differences in adolescent sexual behavior, Social Forces, 1994, 72(3):859-883; Moore KA et al., 1995, op. cit. (see reference 9); and Hofferth SL and Hayes CD, 1987, op. cit. (see reference 9).

Lynch CO, Risk and protective factors associated with adolescent sexual activity, Adolescent & Family Health, 2001, 2(3):99-107; Brewster KL, Neighborhood context and the transition to sexual activity among young black women, Demography, 1994, 31(4):603-614; and Brewster KL, 1994, op. cit. (see reference 14).

Miller BC et al., 1997, op. cit. (see reference 14); East PL, The younger sisters of childbearing adolescents: their attitudes, expectations and behaviors, Child Development, 1996, 67(2):267-284; Romer D et al., Social influences on the sexual behavior of youth at risk for HIV exposure, American Journal of Public Health, 1994, 84(6):977-985; Stanton BF el al., Sexual practices and intentions among preadolescent and early adolescent low-income urban African-Americans, Pediatrics, 1994, 93(6):966-973; and Stanton BF et al., Longitudinal stability and predictability of sexual perceptions, intentions, and behaviors among early adolescent African-Americans, Journal of Adolescent Health, 1996, 18(1):10-19.

Moore KA et al., 1995, op. cit. (see reference 9); and Hofferth SL and Hayes CD, 1987, op. cit. (see reference 9); Miller KS et al., Patterns of condom use among adolescents: the impact of mother-adolescent communication, American Journal of Public Health, 1998, 88(10):1542-1544; Miller BC, Families Matter: A Research Synthesis of Family Influences on Adolescent Pregnancy, Washington, DC: National Campaign to Prevent Teen Pregnancy, 1998; Jaccard J and Dittus PJ, Adolescent perceptions of maternal approval of birth control and sexual risk behavior, American Journal of Public Health, 2000, 90(9):1426-1430; and Resnick MD et al., Protecting adolescents from harm: findings from the National Longitudinal Study of Adolescent Health, Journal of the American Medical Association, 1997, 278(10):823-832.

21. Galavotti C et al., 1995, op. cit. (see reference 19); and Overby KJ and Kegeles SM, 1994, op. cit. (see reference 20).

22. Moore KA et al., 1995, op. cit. (see reference 9); and Hofferth SL and Hayes CD, 1987, op. cit. (see reference 9).

30. Abma JC et al., 1997, op. cit. (see reference 1); and Abma JC, Driscoll A and Moore K, 1998, op. cit. (see reference 25).

35. Abma JC, Driscoll A and Moore K, 1998, op. cit. (see reference 25).

36. Warren CW et al., 1998, op. cit. (see reference 11).

Authors' Affiliations

Debra Kalmuss is professor of clinical public health, Andrew Davidson is professor of public health and Alwyn Cohall is associate professor of clinical public health, all at the Joseph Mailman School of Public Health, Columbia University, New York. Danielle Laraque is associate professor and chief, Department of Pediatrics, Mount Sinai Medical Center, New York. Carol Cassell is senior health scientist, Dyncorps, Atlanta.

Acknowledgment

This comment and the project it describes were supported by grant U48/209663 from the Centers for Disease Control and Prevention.

Disclaimer The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.

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Preventing Sexual Risk Behaviors and Pregnancy Among Teenagers: Linking Research and Programs

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Recent trends in adolescent sexual behavior offer mixed messages.

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'Safe Sex' means risky sex for teenagers

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'Safe Sex' means risky sex for teenagers

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This news article is not a credible source, but does mention studies conducted in Spain about teenager's perceptions of what 'safe sex' means. This article mentions that using the term having 'safe sex' rather than 'safer sex' can give adolescents confidence to start having sex while still in school and can 'increase their risk of pregnancy and sexually transmitted infections'.

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June 18, 2015 ( MercatorNet) -- For the teenager curious about the experience of having sex, but vaguely aware that pregnancy and disease are possible outcomes, the Family Planning of New South Wales website is reassuring. It says:

This youth friendly safe sex pack, encourages safer sexual behaviours to help prevent sexually transmissible infection and unplanned pregnancy.

Specially designed by Family Planning NSW, the experts in reproductive and sexual health, each safe sex pack contains:

* one condom

* one lube sachet

* step-by-step directions on how to correctly use a condom, and

* how to contact FPNSW for more information and support about sexual health.

All this comes packaged in a slim cardboard pack which easily slips into a pocket or wallet.

Yes, it says "safer" once, but "safe sex" twice, and that's what the curious teenager is going to remember, especially when further information tells him, " Keep It Safe, Keep It Sexy ". Sexy, that's what he wanted to hear.

But how safe is the condom? Well, "98 percent effective when used correctly every time," sounds quite good, if not perfect, but "85 percent with typical use" sounds a bit risky - and, seriously, what would be the score of an average teenager?

"Safe sex" is one of the great deceptions of our age. It speaks volumes about the prevailing philosophy of sex (or lack of philosophy) but from a technical point of view it says not nearly enough. And yet it's a slogan that has given many adolescents the confidence to start having sex while still in school, increasing their risk of pregnancy and sexually transmitted infections, including HIV.

This has been demonstrated by researchers at the University of Navarre in Spain. As part of a larger international cross-sectional study -- Project YOURLIFE, on what youth in developing countries think and feel about relationships, love and sexuality -- they asked nearly 9000 students aged 13 to 18 about the risk of being infected with HIV if a person has sex using condoms.

The study, led by public health specialist Jokin de Irala, found that one out of seven of the young people believed condoms are 100 percent effective. They also found that these "safe-sex believers" were collectively 82 percent more likely to have had sex than those without such a belief -- although they were no more likely to use a condom the first time they had sex.

This points to what is known in public health circles as "risk compensation". Writing in the BMJ Open last month the authors give the examples of public health measures such as compulsory car seat belts being accompanied by an increase in speeding, or sunscreen promotion leading to people baking themselves for longer on the beach. Indeed, their study shows that some teens are so reassured by the safety of condoms that they don't even use them!

The teenagers in this study live in Catholic majority countries - The Philippines, El Salvador and Peru - where HIV infection rates are estimated at less than 1 percent and are even lower for young people. However, a significant proportion of the general population start sexual activity in their teens, putting them at risk of other sexually transmitted infections, and also HIV. "In all cases, condom use among young people is far from the recommended 100%," the study authors note.

The study sample were from public and private schools in different areas of each country. All students aged 13 to 18 were invited to participate, and those who responded filled in a confidential and anonymous questionnaire which included questions about socio-demographic information, as well as the youth's leisure activities, opinions, sources of information and communication with parents about love and sex. Schools arranged parental consent.

One in five of the students reported that they were sexually initiated (20.2 percent) but this was much more likely among those who believed there is no risk at all of contracting HIV if one has sex using a condom. Safe sex belief was more frequent among males than females, among Filipinos and Peruvians than among Salvadorians, among those with low or no religiosity, and among students attending public and coeducational schools, compared with private and single sex.

There was a similar correlation between believing condoms kept a girl safe from pregnancy, and becoming sexually active.

The authors comment:

"Some campaigns that promote condom use might be placing too much emphasis on their effectiveness, to the point of conveying the message that their protection is complete. Indeed, although agencies such as the WHO have used the term 'safer' sex instead of 'safe' sex for years, campaigns continue using the 'safe sex' message. [Examples are given] Ambiguous information only stressing condom safety may lead youth to think that sex using condoms is simply 'safe sex'."

Other research has shown that condom users have less interest in basic prevention measures such as delaying sexual initiation, avoiding casual sex or reducing the number of partners, which can undermine or cancel out the effect of using condoms. And this is the most likely interpretation of the reported behaviour of teenagers in the Project YOUR LIFE study.

The study is, by the way, the first of its type to test the relationship between safe sex belief and risk compensation behaviour among teenagers in three different developing countries. The authors conclude: "Overconfidence in condom effectiveness might indeed be contributing to the increase of sexual initiation among adolescents from these countries, and these results could also be relevant in other settings."

A decade ago, confronting the HIV/AIDS pandemic, leading public health experts published a consensus statement in The Lancet medical journal setting out priorities for prevention. When targeting young people, they ordered the priorities thus:

[F]or those who have not started sexual activity, encourage abstinence or delay of sexual onset

After sexual debut, return to abstinence or be mutually faithful with an uninfected partner

For the sexually active, support correct and consistent condom use - which "lowers the risk of HIV (by about 80-90 percent for reported 'always use')" and of other STIs and pregnancy.

In recommending the expansion of prevention programmes in and out of school they also said that "parents should be supported in communicating their values and expectations about sexual behaviour."

No mention of "safe sex" there. Why is it that more than 10 years later the use of this misleading and harmful catch-phrase by agencies targeting youth persists? Which of them gives priority to abstinence and delaying sexual activity? In the light of the latest findings on safe sex belief and risk taking among teenagers, the "Keep it safe, keep it sexy" approach is scientifically and morally indefensible.
Reprinted with permission from MerctorNet.

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'Safe sex' means risky sex for teenagers

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June 18, 2015 ( MercatorNet) -- For the teenager curious about the experience of having sex, but vaguely aware that pregnancy and disease are possible outcomes, the Family Planning of New South Wales website is reassuring. It says: This youth friendly safe sex pack, encourages safer sexual behaviours to help prevent sexually transmissible infection and unplanned pregnancy.

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World Health Organisation - Comparative Quantification of Health Risks Chapter 14 - Unsafe Sex

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World Health Organisation - Comparative Quantification of Health Risks Chapter 14 - Unsafe Sex

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WHO explores the risk factors associated with global diseases - unsafe/risky sex is second in the top ten of all risk factors. This source is credible as it comes from the World Health Organisation, a department of the United Nations and articles in this chapter are peer-reviewed.

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This image is a model of the Theory of Reasoned Action as mentioned in the journal article 'Interpersonal and Interpersonal Factors Influencing Adolescent's Decisions About Having Sex', retrieved from https://commons.wikimedia.org/wiki/File:TRA_(BLUE).jpg

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Intrapersonal and Interpersonal Factors Influencing Adolescents’ Decisions About Having Sex

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Intrapersonal and Interpersonal Factors Influencing Adolescents’ Decisions About Having Sex

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This journal article explores the Theory of Reasoned Action and the Theory of Planned Behaviour to explain the factors that influence adolescents' decisions about sex. This journal article is a credible source as it is peer-reviewed and is also recent (published within the past 10 years)

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Teen Pregnancies Fall But School Sex Ed Doesn’t Work

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Teen Pregnancies Fall But School Sex Ed Doesn’t Work

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This article examines statistics on Abstinence-only sex education programs in the USA that claimed to have caused a fall in teen pregnancy. Upon further investigation, the author finds other studies do not suggest this. This article is not a credible source as it is not a peer-reviewed journal article.

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In "No Surrender," Bruce Springsteen sings: "We learned more from a three-minute record than we ever learned in school." That may not be true for most subjects, but it crystalizes the impact of school-based teen pregnancy prevention classes-and raises serious questions about why we taxpayers continue to finance them.
The Good News
Recently, researchers at the Planned- Parenthood-affiliated Guttmacher Institute announced that teen pregnancies have fallen to their lowest level in 30 years. Since 1990, teen pregnancies have plummeted from 117 per 1,000 to just 45. That's a drop of 62 percent in a generation. Now, compared with the rest of the Western world, the U.S. still has one of the highest teen pregnancy rates, a real problem. But that does not negate the fact that our rate is down by almost two-thirds in 26 years.

In addition, teens are more likely than ever to use contraception. During the 1990s, sexually active teens used birth control, mostly condoms, around half the time. Today the figure is 86 percent.
Abstinence Only?
During the Presidency of George W. Bush (2001-2009), Congress allocated almost $1 billion to abstinence-only school sex education classes, the idea that young people should just say no to sex until marriage. Social conservatives claim that abstinence-only sex education was a huge success proven by the falling rate of teen pregnancies nationwide.

However, University of Georgia researchers analyzed changes in teen pregnancies by state, and found that as states boosted their emphasis on abstinence-only sex education, teen pregnancy rates increased. Teens in states that taught about all contraceptive methods had much lower rates of teen pregnancy. Their conclusion: "Abstinence-only sex education is ineffective in preventing teen pregnancy and may actually contribute to it."
Comprehensive Sex Education?
Meanwhile, social liberals claim that teen pregnancies have fallen because of comprehensive school or community-based sex education programs that (1) encourage delay of sexual initiation, (2) emphasize prevention of sexually transmitted infections (STIs), and (3) discuss all birth control methods, especially condoms because they're easily available and largely prevent both pregnancy and STI transmission. This approach sounds persuasive-until you examine the research.

Recently, the prestigious American Journal of Public Health published a special supplement devoted entirely to evaluations of non-abstinence-only teen pregnancy prevention programs around the United States. The 15 studies evaluated roll-outs of programs that had appeared promising in previous pilot studies. The results were, at best, disappointing:

* Only two (13 percent) showed any decrease in teen sex or pregnancies-and those decreases were small, on the order of 2 percent.

* Two more (13 percent) showed equivocal results-no fewer pregnancies among white and African-American teens, but a slight decrease among Hispanic teens.

* Eleven (74 percent) showed that comprehensive sex education programs have no impact on teen sex, pregnancies, or STIs.

In other words, comprehensive sex education classes are pretty much a bust. But social liberals take their effectiveness as an article of faith. To show how ineffective school-based sex education is, I'll briefly summarize the 15 new studies.

The two studies that showed a slight decrease in pregnancies in some teens:

* University of Louisville scientists evaluated a sex education program that enrolled 1,448 teens in 23 community-based programs in Louisville (e.g. Boys and Girls Clubs). After six months, participants were slightly less likely to have sex and slightly more likely to use birth control.

* A researcher at California Baptist University in Riverside compared pregnancies among teens in six school districts across Southern California-2,483 who took a comprehensive sex education class versus 1,784 who did not. Participants showed slight behavior changes-intercourse delayed a few months and a bit greater likelihood of using birth control.

The two studies that showed equivocal results:

* Boston researchers evaluated a three-year teen pregnancy prevention program taught to 1,344 middle-school youth around Massachusetts. It had no impact on teen sex or pregnancies, except in Hispanic girls, who showed a slight decrease.

* University of Colorado researchers assessed the effectiveness of a text-message-based pregnancy prevention program on 852 members of eight Boys and Girls Clubs around Denver. After four years, there were no significant differences, except among Hispanic youth, whose pregnancies dropped 2 percent.

And the 11 studies that showed no benefit:

* Cambridge, Massachusetts, researchers evaluated a 12-month program attended by 1,808 teen girls at sites across Minnesota, Tennessee, and Florida. It had no effect on their sexual activity.

* The same researchers tracked 12-month outcomes among 2,689 high school students in 150 sex education classes in St. Louis, Missouri; Austin, Texas; and San Diego, California. Compared with youths who did not participate, the program "was unsuccessful in changing sexual behavior."

* The Cambridge group also evaluated a six-month sex education class aimed specifically at Hispanic youth-2,169 Latino teens who did or did not participate at schools across Arizona, California, and Massachusetts. Participants became more knowledgeable about STIs and birth control, but "these changes did not translate to improvements in teens' reported sexual risk behaviors."

* South Carolina researchers recruited 3,143 teens in 24 schools across the state who either did or did not participate in a comprehensive sex education program. After one year, the program showed no benefit.

* New Orleans researchers compared outcomes among teens who either did or did not participate in a sex education program over three summers as part of a jobs program. "We found no statistically significant difference in self-reported frequency of sex or condom use."

* University of Texas researchers enrolled 1,437 Texas high school students in a pregnancy prevention program. After three school years, compared with controls who did not participate, there were "no differences in pregnancy rates."

* Hawaii scientists surveyed the sexual knowledge and behavior of 2,203 students at 36 middle schools across Hawaii and then presented a culturally sensitive sex education program. After 12 months, students knew more, but the knowledge "did not lead to detectable changes in behavior."

* Princeton researchers presented a sex education class at seven Chicago middle schools but not at seven others. After one school year, students who received the program knew more about STIs and contraception, but the two groups did not differ in sexual behavior.

* University of Chicago researchers presented a pregnancy prevention program to 1,455 students at 14 Indiana high schools. After a year, "no statistically significant differences were observed for reported sexual intercourse."

* Scientists in Louisiana and Rochester, New York, the compared pregnancy rates of 5,739 teens who did or did not participate in a comprehensive sex education class. "We found no differences between the intervention and control youths on delay of sexual onset."

* Finally, the largest study: Researchers around the country analyzed the Teen Outreach Program (TOP), one of the nation's most popular teen pregnancy prevention efforts. They tracked 35,000 teens at 193 high schools in 190 cities in 35 states. After two years, "there was little evidence of effectiveness in reducing teen sexual risk-taking."

The two studies that showed equivocal results produced benefits so scant that, for all practical purposes, they must be considered failures. So we have two studies showing that comprehensive teen sex education classes produce a slight decrease in teen sex and pregnancies (13 percent of trials), and 13 that show no persuasive benefit (87 percent). While abstinence-only sex education is a total bust, comprehensive sex ed is almost as worthless.
Who Deserves the Credit for Falling Teen Pregnancy Rates?
But since 1990, teen pregnancies have plummeted 62 percent. How is this possible? Because parents have become more willing to discuss sex with their children-and the kids listen.

I hasten to add that when my two adult children were teens, they seemed to ignore-or scoff at-everything my wife and I said. But a good deal of research shows that children pay close attention to what parents say about sex and to the behavior they model.

Sex is difficult to discuss with one's children, and many parents don't say a word. That's why, starting in the late 1960s, comprehensive sex education was introduced into schools-because parents were so reluctant to discuss it. But in 1981, AIDS appeared, and for a decade, it meant almost certain death. As a result of AIDS, parents of the 1980s overcame their reticence and spoke up about contraception, particularly condoms, which prevent both pregnancy and HIV transmission. When our children were teens we told them that it was their decision when they became sexual, but that when they did, we would be happy to supply them with all the condoms and lube they needed.

Thanks to parental intervention, teens delayed first intercourse. During the 1980s, well over half of teens reported intercourse by high school graduation. Now the figure is less than half.

And thanks to parents, teen condom use is at an all-time high, and teen pregnancies have fallen to their lowest level in decades.

Compared with a generation ago, today's teens are more likely to have parents who speak up about sexual responsibility. That suggests that when they become parents, today's teens should also talk about contraception and STI prevention with their kids.

Instead of spending millions of dollars annually on sex education programs that produce little or no benefit, funding should go to programs that help parents discuss sex with their children-evening and weekend classes for parents.

References:

Abe, Y. et al. "Culturally Responsive Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program for Middle School Students in Hawaii," American Journal of Public Health (2016) 106:S110.

Barbee, A.P. et al. "Impact of Two Adolescent Pregnancy Prevention Interventions on Risky Sexual Behavior: A Three-Arm Cluster Randomized Control Trial," American Journal of Public Health (2016) 106:S85.

Boonstra, H. "Teen Pregnancy: Trends and Lessons Learned," Guttmacher Policy Review (2002) https://www.guttmacher.org/gpr/2002/02/teen-pregnancy-trends-and-lessons....

Bull, S. et al. "Text Messaging, Teen Outreach Program, and Sexual Health Behavior: A Cluster Randomized Trial," American Journal of Public Health (2016) 106:S117.

Calise, T.V. et al. "'Healthy Futures' Program and Adolescent Sexual Behaviors in 3 Massachusetts Cities: A Randomized Controlled Trial," American Journal of Public Health (2016) 106:S103.

Finer, L.B. and M.R.Zolna. "Declines in Unintended Pregnancy in the United States: 2008-2011," New England Journal of Medicine (2016) 374:843.

Francis, K. et al. "Scalability of an Evidence-Based Adolescent Pregnancy Prevention Program: New Evidence from 5 Cluster-Randomized Evaluations of the Teen Outreach Program," American Journal of Public Health (2016) 106:S32.

Gelfond, J. et al. "Preventing Pregnancy in High School Students: Observations From a 3-Year Longitudinal, Quasi-Experimental Study," American Journal of Public Health (2016) 106:S97.

Goesling, B. et al. "Impacts of an Enhances Family Health and Sexuality Module of the Health Teacher Middle-School Curriculum: A Cluster Randomized Trial," American Journal of Public Health (2016) 106:S125.

Jenner, E. et al. "Impact of an Intervention Designed to Reduce Sexual Health Risk Behaviors of African-American Adolescents: Results of a Randomized Controlled Trial," American Journal of Public Health (2016) 106:S78.

Kelsey, M. et al. "Replicating "Reducing the Risk:" 12-onth Impacts of a Cluster Randomized Trial," American Journal of Public Health (2016) 106:S45.

Kelsey, M. et al. "Replicating the Safer Sex Intervention: 9-Month Impact Findings of a Randomized Controlled Trial," American Journal of Public Health (2016) 106:S53.

Kelsey, M. et al. "Replicating 'Cuidate!:' 6-Month Impact Findings of a Randomized Controlled Trial," American Journal of Public Health (2016) 106:S70.

LaChance, R.B. "A Clustered Randomized Controlled Trial of the Positive Prevention PLUS Adolescent Pregnancy Prevention Program," American Journal of Public Health (2016) 106:S91.

Lindberg, L. et al. " Understanding the Decline in Adolescent Fertility in the United States, 2007-2012," Journal of Adolescent Health (2016) 59:577.

Potter, S.C. et al. "'It's Your Game...Keep It Real' in South Carolina: A Group Randomization Trial Evaluating the Replication of an Evidence-Based Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program," American Journal of Public Health (2016) 106:S60.

Robinson, W.T. et al. "Randomized Trial of the Teen Outreach Program in Louisiana and Rochester, New York," American Journal of Public Health (2016) 106:S39.

Stanger-Hall, K.F. and D.W. Hall. "Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S.," PlosOne. http://dx.doi.org/10.1371/journal.pone.0024658.

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Teen Pregnancies Fall But School Sex Ed Doesn't Work. Huh?

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In "No Surrender," Bruce Springsteen sings: "We learned more from a three-minute record than we ever learned in school." That may not be true for most subjects, but it crystalizes the impact of school-based teen pregnancy prevention classes-and raises serious questions about why we taxpayers continue to finance them.